Use LawDepot’s printable PDF template to customize a directive that suits your needs and preferences, while also complying with the laws of your state.
1. Give or withhold consent to specific health treatments
Specify your desired level of care if in a terminal condition, permanent coma, or vegetative state.
Terminally ill or injured means you have an incurable condition that limits your life expectancy. A permanent coma or vegetative state is when there’s a reasonable degree of certainty that you cannot think, feel, knowingly move, or be aware of living. Often, there’s little hope for improvement.
In these cases, consider if you wish to receive:
- Life Support: life-sustaining procedures that restore function to an organ through medical intervention, such as CPR, defibrillators, assisted breathing, or dialysis.
- Tube feeding: continuous life support that artificially administers food and water.
- Comfort care: treatments that manage symptoms, pain relief, and quality of life.
2. Provide personal details
Include your full name and address.
If you can become pregnant, consider whether you want to suspend your Health Care Directive if there’s a chance your fetus can survive.
3. If desired, appoint a health care agent
LawDepot’s Living Will template allows you to include a Medical Power of Attorney. With this form, you can appoint a representative and an alternate to act if your first choice is unavailable. If doing so, include their:
- Full name
- Address
- Phone number
- Relationship to you
4. Add any special instructions, if applicable
Consider any unique circumstances or preferences you may want to include. For example, if your religious beliefs prohibit certain health care treatments.
Remember that you cannot include any instructions unrelated to health care planning.
5. Sign the document
Depending on your state’s law, you’ll need to sign your Living Will in front of at least two witnesses, a notary public, or both. LawDepot’s Living Will template will also include a Statement of Witnesses if your state requires it. In this statement, your witnesses swear they meet the legal requirements to witness and sign the document.
Also, it’s best practice to keep a record of any copies you make. For instance, you, your health care agent (if applicable), and your family doctor should each keep a copy. It’s helpful to keep a record of who owns a copy so that you know who to contact whenever you update your health care preferences.